February 13, 2013

What We Mean When We Say “Carpenters”

How it's used:“The carpenters love to get in, use their tools, and get out, but they should pay more attention to the patient. Remember the patient?”

Who uses it:Doctors playing a game of one-upmanship / med students over drinks / people who used to write for “Scrubs.”

Hospitals, as anyone who has ever watched network television knows, are as cliquey as high school cafeterias. The swaggering surgeons are the cool kids, often known as “blades” or “scalpel jocks.” To them, the internists are “fleas,” as in, the last things to leave a dying dog. Vascular surgeons are “plumbers” (all those arteries), and psychiatrists are, of course, “shrinks.” Patients also get nicknames, and sometimes they’re vile: Dementia-ridden seniors wasting doctors’ time are known in 1978’s every-resident-reads-it cult novel The House of God as “gomers”—“get out of my emergency room.”

When orthopedic surgeons call themselves “carpenters,” it’s self-deprecation. Nine in ten are men, and part of their job isto treat your skeleton like a piece of furniture, using saws, retractors, drills, pliers, and awls, as well as significant physical strength, to mend unhealthy bones. But when other doctors use the term, it can connote condescension with a dash of concern—a slightly more high-minded version of the crack, “An orthopedist is as strong as an ox, and half as smart.”

The embedded critique has always been that orthopedists fail to appreciate that repairing a human leg is vastly more complex heuristically, emotionally, and medically than repairing a table leg—even if mechanically the procedures are not dissimilar. But a recent study suggests that the “carpenters” epithet also has a darker dimension to it. Researchers found that the majority of Canadian orthopedists didn’t recognize the frequent link between women who visit with broken bones and domestic violence; a significant chunk even thought abuse was usually the woman’s fault. Said the orthopedist who led the study: “We shouldn’t think of ourselves as carpenters who fix broken bones, but doctors who heal the whole self.”